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Senate | May 8, 2013 | Committee Room | Finance

Good afternoon. The Finance Committee will come to order. Welcome.
Today our pages in the Senate are Kristen Mora, Senator Jenkins, Jordan
Thomas, representing sponsor by Senator Blue. Our Sergeant at Arms
staff is Earnie Shell, Donna Blake, Anderson Meadows and Canton Lewis.
You're welcomed. We're not going to be hearing House Bill 484, the
Permitting of Wind Energy Facility, we will be hearing it in another
finance committee next week. We will be hearing today, Senate Bill 473,
Health Cost Care and Reduction and Transparency, going to be given by
Senator Rucho. We have a PCS, a motion to hear the PCS by Senator Hise,
all in favor say aye.
[SPEAKER CHANGES]Aye.
[SPEAKER CHANGES]Opposed no. Senator Rucho.
[SPEAKER CHANGES]Mr. Chairman, thank you, members of the Finance
Committee, it's good to be back. I know we had some good questions and
good debate last time. Senator Tarte was helpful in putting some
simplicity and understanding. We've also got some great feedback from
many of the stake holders. I'm going to very, go over the high points,
Ms. Reilly will help us with some additional detail as this bill goes
forward, and so, let me start. What this is, is the first time that we
can start to get some cost information on various hospital procedures as
part of our cost transparency, and I don't know if you've heard this
morning, but apparently the federal authorities have been collecting
this information for a number of years. We'll have a opportunity to
compare it to North Carolina. Actually there was one example they
mentioned on the news this morning that said that there was a surgical
procedure done at one hospital and it cost $8,000 and the same surgical
procedure was done at another hospital and it cost $38,000. Maybe we
can find out why those things are so different. And again, this is all
about providing the opportunity for consumers, and also for the
individuals, the business people that are paying the bills on health
care, to start to get a better picture as to what is the real cost of
health care, and where they should put their health care dollars, and
the like. So, this is an effort to set the platform in place, and
understand, this is a first step in a process so we can find some of the
information on how we can best get control over the cost of health care
that's so important to our future. The cost that would be included
would be charged to someone who is uninsured, the average negotiated
payment for the uninsured person, the Medicaid rate, the Medicare rate,
the range of commercial payments, and the state health plan rate. That
is the gambit of what the State of North Carolina and the consumers
would be interested in. We also have some feedback and decided that the
best way to collect this data and use a repository is VHHS will collect
this data, not NC Health Informations Exchange. And there were
questions on who owned the information, and the like, and what we've
done is eliminated that concern completely, and it will be part of the
Medical Care Data Act. We also changed the fact that we moved away from
episodes of care to a building block of that, and that is DRGs, every
health care provider, every hospital facility understands exactly what
are DRGs. There are many thousands of them, and if you lump a bunch of
DRGs together, that is one episode of care, basically. But what we'll
be allowed to do is get a clear picture of not bundling, but what each
of those costs will be, so it is actually a more knowledgeable way of
collecting the cost data. We've decided to do the top 100 DRGs and
report that information for hospital out-patient settings, for hospital
settings, ambulatory surgical facilities, and we'll change a little bit
on those because they have a different terminology called Hicks Picks,
you don't want me to explain that to you. But what is does do, is we'll
look at the top 20 surgical procedures in ambulatory care, and the top
imaging procedures in ambulatory care. It would give us a good cross
section of what health care costs would be under the most used
procedures.

Also have a portion on certain charge of payments and what that is is
help kids services charges or accepted payment for any health care
procedure or component of health care or procedures. Was not performed
or supply unlawfully what that really means this was part of the
radiology section. With some input from every body we decided that the
best way to manage this is not to look at radiology but determine what
cost would be or remove any possibility of duplication of a procedure.
Trough any medical or surgical procedures, or DRGs it didn't target one
specific area. What it is is a universal system that we will not,
universal statement that we will not. State government will not be
involved or part of any contract that will allow for a double costing of
a procedure. And remember by doing this and whether its the entire
transparency bill or this section, its all about controlling health care
cost. Which we are all trying to get done. Part four will also talk
about the fact that we prohibit still a UNC and ECU form utilizing dead
off collection procedures to collect outstanding debts to tactual
garnishment of tax refund, lottery winnings and alike. We believe that
UNC and ECU, great institutions, should be treated like any other
hospital and therefore would be able to use the normal procedure trough
the legal system. As any other hospital facility or any other business
for that mater. And then we are talking about fair billing practices.
What that is, this is the part talking about the fact that when you get
a bill, when you requested as a patience. You will have one that you can
actually understand in its design language comprehensible to an ordinary
lay person. That means the bill will come in there, won't be bundling
it, will be clear as to what you are charged for the procedure all the
components of the procedure. So once you sit down and try to understand
what you been bill for, you will have a clear understanding. That goes
along way for helping the process. Also part of the fair billing
practice section, the bill also prohibits leans from attaching to
primary residence's of a husband or wife when there spouse has died. It
is trying to be sure that the consumer has some protection. The
governments entity to manage care and control, we are not specifically
the telling CCNC that they need to have or not have people on their
board as it was question earlier. But more importantly wanting to
encourage them to put on that board, not just the provider of health
care those are the ones that would receive the money. But some folks on
that board that are the payers on it. The ones that buy the insurance
for their employers or that pay it individually so that they have a
full understanding on what it cost. But more importantly how does that
business entity pay for it. Those would be, the bill will describe by
the section by the president Pro Temp and the speaker. Hopefully they'll
put those folks forward. Mr. chairman that is a quick over view.
[SPEAKER CHANGES].
Mr. Rayley has anything else.
[SPEAKER CHANGES].
Thank you senator Rucho do you have any thing else you would like add ??
[SPEAKER CHANGES].
I really don't have a whole lot to add senator Rucho when trough that in
great detail. I would be happy to do a line by line if you want though.
[SPEAKER CHANGES].
what is the pleasure Mrs. dale
[SPEAKER CHANGES].
no takes on that but if you have any question you can address them.
[SPEAKER CHANGES].
thank you. We will open the floor to question from the members of the
comity. Question, numbers for senator Rucho. Senator Woodard.
[SPEAKER CHANGES].
Thank you Mr. chair on page two senator Rucho, line 37. I'm trying to
think trough this. But the hospitals will give the amount of payments
that they have received, form the five largest health insurers. I'm
wondering why you limited to the five largest. And two, I'm wondering
whether that might have some effect on the competitive nature, on what
this health insurance do. Are you basically, not reviling the full
contract of each health insurance?
[SPEAKER CHANGES].
we are trying to act.

we had my cities. there was some concerns about negotiated prices in an
proprietary information and what we try to do to get it average and a
range so that there can be some cap harasses without losing proprietary
information and follow-up Mister and so you don't end up putting any
carrier at a disadvantage of those who want to undercut correct whenever
the issue follows just one of page three. now, beginning on the eighteen
Steve that the disclosure of charity care policy and cost and use the
EEC are effective. the information must be given a format and on a
schedule pretty much determined by the State Department. are you saying
that they have to adopt a reporting period different than the reporting
period. nineties
[SPEAKER CHANGES]
my understanding is in and if I'm wrong, will get correct information is
there making this report. anyhow, in which is directing you to the
repository in a list with the schedule H ninety five pictures of their
doing it on the same
[SPEAKER CHANGES]
when they found the nine nineties. that's when the file in it, rather
than having a valid on and on a more current bassist goes than ninety
legs about a year and a half or two years of that provides that
information be provided annually to the departments would be what was
available
that your questions are the attempts that runs our
[SPEAKER CHANGES]
thank you terms may be a question for staff, a notice of that does have
fiscal note on us, as does have a fiscal impact someone is trying to
decipher what the fiscal impact of their cost, say in your who give
evidence of force
[SPEAKER CHANGES]
thanks
research division, nothing will impact of the state is not in the
general fund. that's why you don't get on the table on the front of the
front of the book on that. however, there is a cost to me. see you that
the late VCU faculty practice plan author community healthcare system,
and that by not being allowed to collect revenue using the setup debt
collection act, they will be losing the revenue that they are currently
collecting that grew his procedures to process and distribute to third
minds DVDs they would be losing that revenue they would find another
mechanism to to talk collected through similar collecting agency other
than using the Department of revenue is neglecting each correct. there
are other mechanisms that UN continues to attend to collector
unallocated. they already are, are able to use other mechanisms to
collect revenue as well. having to use the FECA to collect us. however,
if you are other mechanisms that I did so good
I want to thank you for bringing this bill forward. I can tell you what
pleases me the think that this was serious of a movement towards
reducing our healthcare costs also be similar to understand my medical
bills through change without allowed us to the medical and/or local
degree in the case when the times of paper that looked for a favorable
report register. we have a couple of moral questions and is thank you
sincerely good in a novel safe use it to Senator Brown joins me in
trying to get this accomplished in this is any bad news. it goes to
Senator Brown and only good news to me, we would expect nothing else to
do this at the
same original also thank you for writing this forward. I think that a
lot of hard work into it. now they give CNN the good thing for the
citizens of North Carolina understanding wheels from the hospital and he
was moving. thank you, Sharon Johnson reaches around again. I grew that
certain cooking so you had to have a loan agreement that you will agree.
does you no good and really medical bills you all had New Year's price
and for my clients and it's still very hard to interpret in the
indecipherable ethic, yet I have a special degree in medical billing or
something like that should have universities won't be created, PhD, for
that is that his program is sorely overdue. I used to have a medical
savings entail and how is God walked past with Cisco calls me when I can
pay him a medical savings account that I could ever tell me that you
know I will restate maybe this year you'll you'll find out in three
months

I'm looking forward to voting for this one on the floor. [SPEAKER
CHANGES] Thank you. Its designed so that the individual can make a
decision based on the fact. You go out to Walmart or some place you know
what the cost is. Well we may not get right into that degree but we'll
get a lot closer with this. Thank you. [SPEAKER CHANGES] Thank you
senator Daniel. Thank you mr chairman. Senator Rucho in regards to the
amount collected in the chart over the past five years. The garnishments
from these university high schools. Does the staff know how many
garnishments it took to get to that level so that they may have an idea
of how many cases they would have to file to collect that? [SPEAKER
CHANGES] Thank you. I'll allow the staff to answer if you can please.
[SPEAKER CHANGES] Denise Harp physical research division. I don't have
that information available but could get it from the University system.
[SPEAKER CHANGES] Thank you. OK anyone else in the committee? Any more
questions? If not we will hear from the audience at this time. If that's
ok? We do have a sign up sheet to not have them. And we have a few
people that want to speak. Chuck Stone. Please sir if you would turn on
the mic. Introduce yourself. [SPEAKER CHANGES] Thank you Mr Chairman.
Chuck stone obvious for state employs association for North Carolina. We
support this bill. I pray the concerns about the ECU med school UNC med
school that it may well be state employs and the state health plan may
be overpaying well in excess of 300 million dollars per year for
hospital cost. We urge you to support this bill. Lets put the state
health plan on sound financial footing. [SPEAKER CHANGES] Thank you mr
stone. Cody Hand, welcome back. [SPEAKER CHANGES] Thank you. Good
afternoon everybody. Cody Hand, North Carolina hospital association.
First of all Senator Reach I thank you so much for working on this with
us on this bill. The first version that came out I think it was a good
bill but it was something that we were having problems complying with
given the terminology so. Senator Reach you and your staff have been
very good at working with us to get this to something that we can be
very proud of. A few points, first of all we're very proud of our
charity care policies. We are fine posting those, we want everybody to
know first of all that we have charity care and we want it to be
available to everybody who qualifies. Second of all that we spend a lot
money on charity care every year so thank you for bringing that ?? ??.
One thing that I do wanna talk about and senator Reach and I have talked
about this. Is the data that you're going to be getting from the
hospital is hospital data only. We have no control of what
anesthesiologist charge and we have no control over when they charge
that. And we cant know that because of the HIPPA laws. The same applies
to the surgeons and the physicians that are not employed by our
hospitals. So while we do think this is a great step forward until we
can get that full picture of what happens in a hospital facility based
on all those indpendent charges. It's only gonna be half of the picture.
I would encourage you to tell all of your patients and all of your
constituents. To go to their hospital when they need a procedure and
give them their insurance information or if their uninsured, their
financial information, so that we can give them a picture of what it
would look like for them. Really our hospital charges mean nothing until
we take into account each individual patient and everyone of our
hospitals is going to do that. Again senator Rucho I thank you so much.
[SPEAKER CHANGES] Senator Rucho. [SPEAKER CHANGES] Thank you. We
appreciate your help in trying to make this a better bill. And
understand the members of the committee this is the platform that we
start with. We will refine this and include what will the anesthesia
cost primary physician's cost, but it all has to have a starting point.
We have a platform and then we can build on it accordingly. [SPEAKER
CHANGES] Thank you sir. Since there's no more comments or questions, we
have a motion by senator Cooke unfavorable to the original. Favorable to
the PCS. All those in favor of the motion please say aye. Opposed no.
Ayes have it. Motion carried. [SPEAKER CHANGES] Thank you members of the
finance committee and appreciate you helpin. [SPEAKER CHANGES] If
there's nothing else to come before the committee today the committee is
adjourned.

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